Emily Oster

7 min Read Emily Oster

Emily Oster

Pregnancy & Kids: COVID Data Updates

Emily Oster

7 min Read

Early on in the COVID-19 pandemic it seemed like there was new data coming out every day. Our knowledge about the consequences of the disease in pregnancy, kids, adults, anyone, was evolving very fast. The pace has slowed, however, as things stabilize. It isn’t that there aren’t open questions or more to learn, but given how much we already know, incremental advances are smaller.

In the case of pregnancy and kids, we have largely settled around two (reassuring) points:

  • Pregnant women do not seem to be at more risk than non-pregnant women of the same age and with similar other risk factors.
  • Children — including infant and up through young teens — seem to be at less risk than older people. They can get very sick, and there is a particular inflammatory syndrome that has been seen in a small number of cases, but they are overall a less affected group.

These basic impressions are increasingly summarized in review articles, like here and here. New data has come in, but nothing which challenges these basic facts. It seems unlikely, to me, that we will learn more either of these are very wrong. Which is different from saying there isn’t more to learn — data below — but that we shouldn’t expect the basic landscape to alter wildly.

With that background, we can ask what new information we have seen.

COVID-19 and Pregnancy

  • Prevalence Some of the new data we’ve gotten in on pregnancy focuses on the prevalence of the virus in pregnant women. This is a group that is relatively easy to study, since they are having blood drawn frequently. A report from one provider in NY finds that of their 757 patients, 12.2% who had known or suspected COVID-19. In contrast, a screening study in Seattle finds only 2.7% of 188 screened patients were positive. These numbers seem in line with the variation across place in overall prevalence. In the NY study, nearly all the cases were mild or moderate (one woman was hospitalized).
  • Placenta A number of readers sent me this (very dense) article, on placental abnormalities in pregnant women with COVID-19. The article reports on a careful study of 16 placentas of women with COVID-19. Among those women affected in the third trimester (nearly all of them), the authors find a higher rate of vascular abnormalities than they would expect. If replicated in a larger sample, this would indicate COVID-19 infection has some impact on the placenta.There is no direct link made here to issues for either mother or baby. The deliveries in the third trimester in this study were normal; there was a second-trimester miscarriage included in the data, but it wasn’t obviously COVID-19 linked. It’s important, in my mind, to be careful not to over-interpret scary-seeming studies like this.
  • Mother to Infant Transmission Mother to infant transmission remains relatively rare. A review article from two weeks ago summarizes 179 cases of women with COVID-19 around delivery. There were 8 infants who showed evidence of SARS-CoV-2 infection, largely asymptomatic or mild. In most cases it seems likely infection occured during or after birth. The question of whether the virus can be transmitted in utero remains somewhat open but it seems at best to be quite rare.

What remains unknown? I think our most significant blind spot is impacts on early trimester pregnancy. This is due, basically, to the timing: people who had COVID-19 in their first or second trimester largely have not delivered yet. I will stress: there isn’t anything in the biology of the virus or what we know so far to suggest significant concerns.

COVID-19 and Kids

One thing that bears saying before we get into new data is that part of why many of us view the data on children as reassuring is that in many respiratory or flu-like illnesses, children are among the most affected groups. If you look, for example, at seasonal flu cases they are highest among children and the elderly — the age pattern of cases, serious illness and death has a U-shape. Higher for young children and old people, lower for younger adults.

We might have expected the same for COVID-19. So the fact that kids seem to be less affected than prime-age adults is notable. I mention this because I think many people read the idea that the data on kids is “reassuring” to say that they cannot get the virus. This isn’t true. They can, and they can get very ill. It is just that they get it less, and less seriously, than adults. This is surprising because we’d expect the opposite.

  • MIS-C The most worrisome discussion about COVID-19 and kids, of late, has been about the risk of a serious inflammatory syndrome. The CDC has labeled this MIS-C; you may also have seen Kawasaki-like syndrome, or PMIS. The bottom line is that a small number of children with current or former COVID-19 infection have been presenting with serious (although largely treatable) illness.
    The NYC Department of Health has a good summary here. The exact sense in which this is linked to COVID-19 is still a bit unclear (only a slim majority of cases have evidence of previous or current COVID-19 infection), but there does seem to be a link and it is biologically plausible. This syndrome is serious and definitely needs medical attention. Fortunately, it is both rare and easy to spot. The symptoms involve many days of a high fever and, basically, your kid seeming really sick. You’d bring them to the doctor for this kind of illness even in the absence of COVID-19.
  • Pediatric Prevalence in NY Not exactly a peer-reviewed study but one pediatric practice in NY sent out an email saying they’d tested 800 of their patients and found 20% had antibodies to COVID-19. If that reflects the general pediatric population, it suggests a lot of kids had asymptomatic or mild infection in NY. It also puts in further perspective that the serious complications we have seen are very rare.
  • Case Series from Chicago Closely related to this general issue of serious infection, one case series in Chicago summarizes the situation there. Of the approximately 6300 lab-confirmed cases of COVID-19 in Chicago, 64 were in children 0 to 17. Of those 64, 10 of them were hospitalized. Notably, all of the hospitalized cases involved children with some underlying health issues (chronic lung disease, heart disease, immune compromised, genetic disorder). This whole paper generally reinforces that children are a small share of infection and serious illness is rare, especially among those without underlying health issues.
  • School Transmission The other open question is whether kids transmit the virus. As we open camps and schools, will we see this as a major transmission source? We are starting to get some data in from places that have opened schools.

    In Ireland, a paper reports on transmission from 6 infected people in school settings (3 kids, 3 adults). Of their approximately 1100 school contacts, there were no cases. That seems reassuring.

    France’s education minister reported in a video-conference that they have not seen any case increase from school opening (although video conference statements from policy makers are not quite up to the peer review standard).

    Israel has seen some cases
    as schools have opened. It is not yet clear how much spread there is; individual cases have been identified and students gone into quarantine, but transmission hasn’t been evaluated yet.

    Overall, this is a place we clearly need to know more. I’d personally like to see more data like the Ireland study above, where we are able to track infection spread in schools in a systematic way. I think we’ll see more of that in the coming weeks.

Within the US, I think we will learn much more in the next weeks on this, as day cares and, yes, camps begin to re-open. I hope we’ll take the opportunity to learn from this as we plan out schools in the fall.

It’s becoming increasingly clear that food insecurity is worsening and learning outcomes decaying in the absence of school. And, related to the topic in the last newsletter, these issues are disproportionately affecting Black children and other children of color. The more we can do to figure out how to have kids safely back in the classroom in the fall, the better.

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Do you brand things a certain way to get your kid to accept it? Like calling carrots “rabbit popsicles”? Or telling them to put on their “super speed socks” in the morning? Share your rebrands in the comments below! You never know who you might be helping out 👇

#emilyoster #funnytweets #relatabletweets #parentingjokes #kidssaythedarndestthings

Do you brand things a certain way to get your kid to accept it? Like calling carrots “rabbit popsicles”? Or telling them to put on their “super speed socks” in the morning? Share your rebrands in the comments below! You never know who you might be helping out 👇

#emilyoster #funnytweets #relatabletweets #parentingjokes #kidssaythedarndestthings
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Have you ever panic-googled a parenting question when everyone else is asleep? If so, you’re not alone. 

Today is the first episode of a new biweekly series on my podcast: Late-Night Panic Google. On these mini-episodes, you’ll hear from some familiar names about the questions keeping them up at night, and how data can help. First up: @claireholt!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #emilyoster #claireholt #parentingstruggles #parentingtips #latenightpanicgoogle

Have you ever panic-googled a parenting question when everyone else is asleep? If so, you’re not alone.

Today is the first episode of a new biweekly series on my podcast: Late-Night Panic Google. On these mini-episodes, you’ll hear from some familiar names about the questions keeping them up at night, and how data can help. First up: @claireholt!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #emilyoster #claireholt #parentingstruggles #parentingtips #latenightpanicgoogle
...

Sun safety is a must for all ages, especially babies! Here are my tips for keeping your littlest ones protected in the sunshine:
☀️ Most importantly, limit their time out in hot weather. (They get hotter than you do!)
☀️ Keep them in the shade as much as possible when you’re out.
☀️ Long-sleeve but lightweight clothing is your friend, especially on the beach, where even in the shade you can get sunlight reflecting off different surfaces.
☀️ If you want to add a little sunscreen on their hands and feet? Go for it! But be mindful as baby skin tends to more prone to irritation.

Comment “Link” for a DM to an article on the data around sun and heat exposure for babies.

#sunsafety #babysunscreen #babyhealth #parentdata #emilyoster

Sun safety is a must for all ages, especially babies! Here are my tips for keeping your littlest ones protected in the sunshine:
☀️ Most importantly, limit their time out in hot weather. (They get hotter than you do!)
☀️ Keep them in the shade as much as possible when you’re out.
☀️ Long-sleeve but lightweight clothing is your friend, especially on the beach, where even in the shade you can get sunlight reflecting off different surfaces.
☀️ If you want to add a little sunscreen on their hands and feet? Go for it! But be mindful as baby skin tends to more prone to irritation.

Comment “Link” for a DM to an article on the data around sun and heat exposure for babies.

#sunsafety #babysunscreen #babyhealth #parentdata #emilyoster
...

I’m calling on you today to share your story. I know that many of you have experienced complications during pregnancy, birth, or postpartum. It’s not something we want to talk about, but it’s important that we do. Not just for awareness, but to help people going through it feel a little less alone.

That’s why I’m asking you to post a story, photo, or reel this week with #MyUnexpectedStory and tag me. I’ll re-share as many as I can to amplify. Let’s fill our feeds with these important stories and lift each other up. Our voices can create change. And your story matters. 💙

#theunexpected #emilyoster #pregnancycomplications #pregnancystory

I’m calling on you today to share your story. I know that many of you have experienced complications during pregnancy, birth, or postpartum. It’s not something we want to talk about, but it’s important that we do. Not just for awareness, but to help people going through it feel a little less alone.

That’s why I’m asking you to post a story, photo, or reel this week with #MyUnexpectedStory and tag me. I’ll re-share as many as I can to amplify. Let’s fill our feeds with these important stories and lift each other up. Our voices can create change. And your story matters. 💙

#theunexpected #emilyoster #pregnancycomplications #pregnancystory
...

OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio!

OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio! ...

OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio!

OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio! ...

OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio!

OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio! ...

Is side sleeping important during pregnancy? Comment “Link” for a DM to an article on whether sleep position affects pregnancy outcomes.

Being pregnant makes you tired, and as time goes by, it gets increasingly hard to get comfortable. You were probably instructed to sleep on your side and not your back, but it turns out that advice is not based on very good data.

We now have much better data on this, and the bulk of the evidence seems to reject the link between sleep position and stillbirth or other negative outcomes. So go ahead and get some sleep however you are most comfortable. 💤

Sources:
📖 #ExpectingBetter pp. 160-163
📈 Robert M. Silver et al., “Prospective Evaluation of Maternal Sleep Position Through 30 Weeks of Gestation and Adverse Pregnancy Outcomes,” Obstetrics and Gynecology 134, no. 4 (2019): 667–76. 

#emilyoster #pregnancy #pregnancytips #sleepingposition #pregnantlife

Is side sleeping important during pregnancy? Comment “Link” for a DM to an article on whether sleep position affects pregnancy outcomes.

Being pregnant makes you tired, and as time goes by, it gets increasingly hard to get comfortable. You were probably instructed to sleep on your side and not your back, but it turns out that advice is not based on very good data.

We now have much better data on this, and the bulk of the evidence seems to reject the link between sleep position and stillbirth or other negative outcomes. So go ahead and get some sleep however you are most comfortable. 💤

Sources:
📖 #ExpectingBetter pp. 160-163
📈 Robert M. Silver et al., “Prospective Evaluation of Maternal Sleep Position Through 30 Weeks of Gestation and Adverse Pregnancy Outcomes,” Obstetrics and Gynecology 134, no. 4 (2019): 667–76.

#emilyoster #pregnancy #pregnancytips #sleepingposition #pregnantlife
...

My new book, “The Unexpected: Navigating Pregnancy During and After Complications” is available for preorder at the link in my bio!

I co-wrote #TheUnexpected with my friend and maternal fetal medicine specialist, Dr. Nathan Fox. The unfortunate reality is that about half of pregnancies include complications such as preeclampsia, miscarriage, preterm birth, and postpartum depression. Because these are things not talked about enough, it can not only be an isolating experience, but it can also make treatment harder to access.

The book lays out the data on recurrence and delves into treatment options shown to lower risk for these conditions in subsequent pregnancies. It also guides you through how to have productive conversations and make shared decisions with your doctor. I hope none of you need this book, but if you do, it’ll be here for you 💛

#pregnancy #pregnancycomplications #pregnancyjourney #preeclampsiaawareness #postpartumjourney #emilyoster

My new book, “The Unexpected: Navigating Pregnancy During and After Complications” is available for preorder at the link in my bio!

I co-wrote #TheUnexpected with my friend and maternal fetal medicine specialist, Dr. Nathan Fox. The unfortunate reality is that about half of pregnancies include complications such as preeclampsia, miscarriage, preterm birth, and postpartum depression. Because these are things not talked about enough, it can not only be an isolating experience, but it can also make treatment harder to access.

The book lays out the data on recurrence and delves into treatment options shown to lower risk for these conditions in subsequent pregnancies. It also guides you through how to have productive conversations and make shared decisions with your doctor. I hope none of you need this book, but if you do, it’ll be here for you 💛

#pregnancy #pregnancycomplications #pregnancyjourney #preeclampsiaawareness #postpartumjourney #emilyoster
...

We are better writers than influencers, I promise. Thanks to our kids for filming our unboxing videos. People make this look way too easy. 

Only two weeks until our book “The Unexpected” is here! Preorder at the link in my bio. 💙

We are better writers than influencers, I promise. Thanks to our kids for filming our unboxing videos. People make this look way too easy.

Only two weeks until our book “The Unexpected” is here! Preorder at the link in my bio. 💙
...

Exciting news! We have new, high-quality data that says it’s safe to take Tylenol during pregnancy and there is no link between Tylenol exposure and neurodevelopmental issues in kids. Comment “Link” for a DM to an article exploring this groundbreaking study.

While doctors have long said Tylenol was safe, confusing studies, panic headlines, and even a lawsuit have continually stoked fears in parents. As a result, many pregnant women have chosen not to take it, even if it would help them.

This is why good data is so important! When we can trust the data, we can trust our choices. And this study shows there is no blame to be placed on pregnant women here. So if you have a migraine or fever, please take your Tylenol.

#tylenol #pregnancy #pregnancyhealth #pregnancytips #parentdata #emilyoster

Exciting news! We have new, high-quality data that says it’s safe to take Tylenol during pregnancy and there is no link between Tylenol exposure and neurodevelopmental issues in kids. Comment “Link” for a DM to an article exploring this groundbreaking study.

While doctors have long said Tylenol was safe, confusing studies, panic headlines, and even a lawsuit have continually stoked fears in parents. As a result, many pregnant women have chosen not to take it, even if it would help them.

This is why good data is so important! When we can trust the data, we can trust our choices. And this study shows there is no blame to be placed on pregnant women here. So if you have a migraine or fever, please take your Tylenol.

#tylenol #pregnancy #pregnancyhealth #pregnancytips #parentdata #emilyoster
...

How many words should kids say — and when? Comment “Link” for a DM to an article about language development!

For this graph, researchers used a standardized measure of vocabulary size. Parents were given a survey and checked off all the words and sentences they have heard their child say.

They found that the average child—the 50th percentile line—at 24 months has about 300 words. A child at the 10th percentile—near the bottom of the distribution—has only about 50 words. On the other end, a child at the 90th percentile has close to 600 words. One main takeaway from these graphs is the explosion of language after fourteen or sixteen months. 

What’s valuable about this data is it can give us something beyond a general guideline about when to consider early intervention, and also provide reassurance that there is a significant range in this distribution at all young ages. 

#cribsheet #emilyoster #parentdata #languagedevelopment #firstwords

How many words should kids say — and when? Comment “Link” for a DM to an article about language development!

For this graph, researchers used a standardized measure of vocabulary size. Parents were given a survey and checked off all the words and sentences they have heard their child say.

They found that the average child—the 50th percentile line—at 24 months has about 300 words. A child at the 10th percentile—near the bottom of the distribution—has only about 50 words. On the other end, a child at the 90th percentile has close to 600 words. One main takeaway from these graphs is the explosion of language after fourteen or sixteen months.

What’s valuable about this data is it can give us something beyond a general guideline about when to consider early intervention, and also provide reassurance that there is a significant range in this distribution at all young ages.

#cribsheet #emilyoster #parentdata #languagedevelopment #firstwords
...